Compliance Offier

Job Description

Job Description

Job Title : Compliance Officer

Department : Administration

Reports To : CEO

FLSA Status : Exempt

Date : 12 / 22 / 2023

The Compliance officer, health care, position establishes and implements an effective compliance program to prevent illegal, unethical or improper conduct. The Compliance officer serves the CEO and Governing Board by monitoring and reporting results of the compliance and ethics efforts of the company and in providing guidance for the Board and senior management team on matters relating to reporting and compliance. The compliance officer, together with the Compliance Committee, is authorized to implement all necessary actions to ensure achievement of the objectives of an effective compliance program.

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Develops, initiates, maintains and revises policies and procedures for the general operation of the compliance program and its related activities to prevent illegal, unethical or improper conduct

Manages day-to-day operation of the compliance program.

Develops and periodically reviews and updates Standards of Conduct to ensure continuing currency and relevance in providing guidance to management and employees.

Collaborates with other departments (for example, human resources, chief security officer and health information management director) to direct compliance issues to appropriate existing channels for investigation and resolution.

Consults with general counsel as needed to resolve difficult legal compliance issues.

Responds to alleged violations of rules, regulations, policies, procedures and standards of conduct by evaluating or recommending the initiation of investigative procedures.

Develops and oversees a system for uniform handling of such violations.

Acts as an independent review and evaluation body to ensure that compliance issues and concerns within the organization are being appropriately evaluated, investigated and resolved.

Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.

Identifies potential areas of compliance vulnerability and risk, develops and implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.

Provides reports on a regular basis and, as directed or requested, keeps the Corporate Compliance Committee and senior management informed of the operation and progress of compliance efforts.

Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate or required.

Establishes and provides direction and management of the compliance hotline.

Institutes and maintains an effective compliance communication program for the organization, including promoting a) use of the compliance hotline, b) heightened awareness of standards of conduct, and c) understanding of new and existing compliance issues and related policies and procedures.

Works with the human resource department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees and ongoing training for all employees and managers.

Monitors the performance of the compliance program and related activities on a continuing basis, taking appropriate steps to improve its effectiveness.

Perform other duties

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Demonstrate knowledge of and adhere to regulations policies and procedures pertaining to safety, emergency preparedness, infection control, OSHA, fire safety and hazardous materials

Participate in performance improvement activities as necessary

Maintain confidentiality of patient related issues and adhering to all HIPAA rules and regulations.

Demonstrate effective interpersonal skills

Treat all patients, visitors, and staff members fairly and with respect

Utilize effective communication methods and skills

Ensure personal appearance is business casual and professional at all times

Responsible for wearing identification badge at all times which must be visible and above the waistline

Attend all required meetings and in-service education

Demonstrate flexibility when changes in assignments are necessary

Qualifications

EDUCATION & EXPERIENCE

Three years’ compliance / regulatory experience. 2 of these years must be in healthcare setting

Master’s degree in Healthcare Administration, Public Administration, and Finance or a related field or equivalent professional degree.

Possession of one of the below certifications :

Certified Professional Coder (CPC)

Certified Medical Coder (CMC)

Certified Coding Specialist-Professional (CCSP)

Registered Health Information Technician (RHIT)

Certified in Healthcare Compliance (CHC)

Certified in Healthcare Research Compliance (CHRC)

Certified in Privacy Compliance (CPC)

Certified Compliance and Ethics Professional (CCEP).

Principles and practices of compliance in the health care field, including relevant laws, regulations, policies and standards related to health care fraud, waste and abuse, billing and coding, clinical documentation, privacy and information security, research, and / or ethics;

Complex auditing and program evaluation methods, investigative techniques, and report writing procedures;

Health care organizational structure and compliance program components;

Current legislation and trends affecting health care compliance;

Statistical research and analytical techniques and procedures, and intermediate computer skills including complex spreadsheets and database software;

Advanced communication techniques for gathering, evaluating, and conveying information;

Health care reimbursement and other regulatory requirements, state and federal compliance expectations and enforcements;

Federal and state privacy laws governing healthcare organizations;

Project management;

Health care regulatory and reporting requirements

LANGUAGE / MATH / REASONING ABILITY

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.

Ability to speak effectively before groups of customers or employees of organization.

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

COMPUTER SKILLS

To perform this job successfully, an individual should have knowledge of Word Processing software and Internet software.

Analytical – Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.

Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.

Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to other ideas and tries new things.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Team Work - Balances team and individual responsibilities; Exhibits objectivity and openness to other views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.

Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results.

Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Inspires respect and trust; Accepts feedback from others; Provides vision and inspiration to peers and subordinates; Gives appropriate recognition to others; Displays passion and optimism; Mobilizes others to fulfill the vision.

Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.

Visionary Leadership - Displays passion and optimism; Inspires respect and trust; mobilizes others to fulfill the vision; Provides vision and inspiration to peers and subordinates.

Cost Consciousness - Works within approved budget; Contributes to profits and revenue; Conserves organizational resources.

Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; educates others on the value of diversity; promotes a harassment-free environment; Builds a diverse workforce.

Ethics - Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.

Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

Attendance / Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

Dependability - Follows instructions, responds to the Board of Director’s  direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.

Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.

Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.

Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.

Planning / Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.

Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.

The physical demands for this position include : adequate vision, hearing, and repetitive motion

Light physical activity performing non-strenuous daily activities of an administrative nature

Ascending or descending stairs, ramps and the like, using feet and legs and / or hands and arms

Substantial movements (motion) of the wrist, hands, and / or fingers in a repetitive manner

Bending legs downward and forward by bending leg and spine

Well-lighted, heated and / or air-conditioned indoor office setting with adequate ventilation

Printed Name

Employee Signature Date